Biomedical subjects

G Sennwald

Publications and source records attributed to G Sennwald.

At least 19 recordsLinked to original sources

PubMed1992

[Toxic necrosis following a bite by Naja nigricollis, a therapeutic challenge].

The surgical approach to snake bite lesions remains controversial. As a rule surgery is not recommended. However, the attitude towards severe local effects of envenoming should be revised and treatment made more aggressive, as our case report illustrates: following envenoming by Naja nigricollis, progressive necrosis jeopardized not only the function but also the survival of the hand. In view of this observation, we believe that a restrictive attitude is debatable. At first, immediately after the bite, splinting of the upper extremity is necessary, the hand being in intrinsic-plus position. Close clinical observation is necessary to detect early necrosis or a compartmental pressure-rise. As soon as pressure rises or local necrosis is suspected, extensive debridement with fasciotomy is recommended, especially in the presence of a venom with well known local toxic effects. Soft tissue coverage necessitates extensive flap surgery, such as the pedicled radialis flap, which appears not only to guarantee skin coverage but, by its excellent blood supply, prevents necrosis and allows for regeneration of underlying tissue. Our case confirms the local cytotoxicity of the venom of Naja nigricollis. Local and general effects of the snake bite must be clearly defined. The local development deserves immediate surgical attention, while the systemic effects need intensive medical care.

Adult↗

PubMed1992

[The medical record at the center of medical informatics].

Several areas in medical institutions, particularly the technical and administrative ones have been governed by computers for a long time. The proper medical work field (diagnosis, treatment, follow-up, correspondence and billing) however has hitherto mostly been ignored by data processing. We describe an electronic medical record introduced 4 years ago. All aspects of medical practise and all the specialists involved in patient care are integrated in the electronic document. In the center is a medical base of knowledge adaptable to all specialties as well as an expert system for direct control of the data entered by all concerned persons.

Ambulatory Surgical Procedures↗

PubMed1992

[Malunion of the distal radius and its treatment. Apropos of 122 radii].

We have reviewed 109 out of 122 operations performed for malunion of the distal radius. An excellent or good result was achieved in 80%, with 3% poor and 7% mediocre. Complications occurred in 12.6%. Accurate assessment of the frontal and sagittal angles of the articular surface of the distal radius was necessary in planning the operation, and correct realignment was required to achieve a proper result. Some cases in which an excellent correction was achieved did not produce a satisfactory outcome because of residual problems with soft tissue or ligaments. No patient with carpal instability had a good result. The morphology of the fracture and the sex or activity level of the patient did not influence the result.

Adolescent↗

PubMed1992

[Surgical indications for partial inpatient and ambulatory surgery of the lower extremities].

Outpatient (ambulatory) surgery has become widely accepted in free-standing outpatient surgery centres and in hospitals covering the field of hand surgery as well as, increasingly, the field of lower-extremity surgery. Three factors are decisive for secure ambulatory surgery: adequate material and personal resources guaranteeing a round-the-clock medical service, outpatient anesthesia which focuses mainly on the perioperative care of outpatient surgery, and a well-informed patient. Under these prerogatives the majority of surgical procedures of the lower extremities are performed on an outpatient basis without any undue risk. This includes also the diagnostic and operative arthroscopy of different joints.

Adult↗

PubMed1992

[Biomechanics of the carpus--functional anatomy and movement analysis of the carpal bones].

The often unsatisfactory outcome of attempts to reconstruct ligaments and perform partial arthrodeses of the wrist bones has prompted us to investigate the kinematic behavior of the proximal row of carpal bones in their immediate environment. The movements of the individual bones were observed on fresh autopsy specimens before they were dissected to study the exact location of the interconnecting ligaments. Finally, a special model of epoxy resin was made in which the exact form of the joint surfaces (cartilage surfaces) was maintained. The ligaments were simulated by means of stout threads and, according to the observations recorded in the previous study, attached to the model bones. In this manner a working model resulted that not only proved the correct positioning of the ligaments, but also enabled their function in controlling the movements of the bones during dorsal-palmar flexion and radial-ulnar abduction of the wrist to be established. It was seen that movement of the proximal row of carpal bones is caused primarily by the orientation of the adjoining articular surfaces and limited by the ligaments. Therefore, it is of paramount importance that the friction at the joint surfaces remains as low as possible. If the friction increases, the "floating" bones can no longer slide under load and movement of the hand becomes limited.

Biomechanical Phenomena↗

PubMed1990

[Decompression of the carpal tunnel. Apropos of 16 reoperated cases].

The aim of surgery is the healing of disease, and also the preservation or even the reconstruction of the function of an anatomical structure. In 12 out of 16 second look operations after carpal tunnel release we found luxation or subluxation of the intracarpal content. This suggests that the instability created by surgical release of the retinaculum flexorum is an important factor in postoperative symptoms. Therefore we suggest replacing the lengthwise incision of the retinaculum flexorum by widening of this structure. This serves to enlarge the carpal tunnel without forfeiting the function of the retinaculum flexorum. It acts as a pulley, serves as an anchor to the thenar muscles, and allows mechanical protection to the underlying nerve. The satisfactory results obtained after secondary functional reconstructive surgery suggest the same principle should be applied at the first operation.

Adult↗

PubMed1990

[Recurrent carpal tunnel syndrome--caused by an inadequate surgical technique?].

The carpal tunnel syndrome (CTS) is a common disease, and the decompression of the median nerve is one of the most often performed procedures in surgery. Within our patients from the 1. 12. 1987 to the 1. 12. 1988 we found 16 cases of recurrent CTS. Intraoperatively in more than 60% of the cases we could detect some sort of subluxation or even luxation of the median nerve and severe scarring involving the median nerve and the regenerated transverse carpal ligament in all cases. Considering the anatomy of the transverse carpal ligament, to guide the median nerve and the flexor tendon within the carpal tunnel, as well as serving as origin for the thenar musculature, especially for the opposition, one concludes that the simple dissection of the carpal ligament should be avoided. For the past 4 years we therefore have been performing a widening Z-plasty and reconstruction of the transverse carpal ligament, for the primary CTS as well as for revisions. The favorable postoperative results seem to confirm our theory. We discuss our operative technique as well as the results in CTS revision cases.

Carpal Tunnel Syndrome↗

PubMed1990

[Electronic organization of patient records as a component of integrated medical informatics].

Conventional patient records are not only inconvenient to store, their structure is often not consistent and faulty, research is difficult and quality control is not possible. One solution to this problem is the computerized patient record. It contains all necessary data beginning with the first medical statements and ending with the final results of treatment. At any time and from any with the system connected computer terminal it allows immediate access to all medical records. In addition to medical information also administrative data are stored. The here presented system of a computerized medical record has proven to be an effective tool in the daily work as well for clinical, administrative and research tasks.

Humans↗

PubMed1990

[Recurrent carpal tunnel syndrome. Problems and treatment].

Of 16 patients surgically treated for recurrent carpal tunnel syndrome, 60% demonstrated some degree of palmar subluxation or even luxation of the median nerve and flexor tendons intraoperatively, subsequent to previous simple division of the flexor retinaculum. During the past years, therefore, we have been performing a widening Z-plasty and reconstruction of the flexor retinaculum for surgical treatment of primary or recurrent carpal tunnel syndrome. In this paper, we present and discuss our operative technique and results.

Adult↗

PubMed1990

[Late results of operated scaphoid pseudarthroses].

Beyond elimination of pain, the objective of surgical treatment of scaphoid pseudarthrosis is the prevention of otherwise inevitable arthrosis of the wrist. In a follow-up of twenty-five patients over at least ten years post-operatively, the rate of union, but above all, the development of carpal instability and arthrosis was investigated. In the healed scaphoid, instability did not increase, although signs of arthrosis were found in almost all patients. As a rule, the degree of arthrosis was more pronounced in those cases with persisting subluxation of the lunate and DISI pattern of instability. Consequently, simultaneous correction of lunate subluxation via ligament reconstruction must be recommended when scaphoid pseudarthrosis is to be treated effectively. Late results of this modified procedure are not yet available though.

Adult↗

PubMed1989

[Silastic implant and synovitis].

The silastic implant based on siloxane polymere induces granulomatous synovitis in certain predisposed individuals, a reaction which may continue even after removal of the implant. This is also true of a prosthesis of the trapezium in two of our patients, though to a lesser degree. This is probably the reason why the problem has not yet been widely recognized. The hypothesis is put forward that an enzymatic predisposition may allow chemical degradation of the fragmented silastic implant into a toxic component responsible for the pathologic condition. The slow progression of the lesions is a challenge for the future and puts in question the further use of silastic implants.

Aged↗

PubMed1989

[Arthrodesis of the central support of the carpus. Indications, technic, results].

We have used this operation for the management of pain due to osteoarthritic changes at the radio-scaphoid and capitate-lunate joints. It allows correction of the carpal height by reposition of the flexed lunate, preserves the load bearing capitate-lunate axis, and decompresses the radio-scaphoid joint. We have carried out the procedure in 25 cases. Perilunate instability with osteoarthritic changes were present in 14 wrists; the remainder were consequent to non-union of fractures of the scaphoid with osteoarthrosis, or following complex fracture dislocations. At review 10 patients were free of pain, 12 had occasional pain and 3 were not improved. The mean residual range of movement in the wrist was 49 degrees, with a range from 20 degrees to 80 degrees. Bony union was not achieved in 5 wrists. At operation the lunate is reduced and carpal height restored with realignment of the weight bearing axis. Bone grafts and internal fixation are used.

Adult↗

PubMed1989

[Corrective osteotomy of the distal forearm].

After fractures of the distal forearm the final degree of malunion correlates well with the amount of discomfort and limitation of ROM. With this study we like to demonstrate that corrective osteotomies will improve the overall results. We analyzed retrospectively 94 cases. Corrective osteotomy of the distal radius as well as shortening of the ulna ended in more than 70% of the cases in good and very good results. We conclude there is no age limitation for performing corrective osteotomies of the distal forearm despite the published results in the world literature.

Adolescent↗

PubMed1989

[The position of the os triquetrum in the classical roentgen picture. Clinical relevance].

The first carpal row acts as an important functional unit. The position of the lunate and scaphoid and their relationship within the wrist are wellknown. On the lateral radiography they are easily recognized so that one is able to define and measure accurately their relative position. The position of the triquetrum and its relationship to the adjacent bones have not been previously very well defined. However, it is possible to consistently identify the axis of the pisotriquetral joint on the lateral radiography. From this line the position of the triquetrum can be inferred. We measured the axis of the pisotriquetral joint in a random sample of 102 cases (40 men and 62 women), and compared it to the axis of the radius. Thus, using the pisiform axis as a marker, the position of the triquetrum can be accurately defined. Its movement correlates well with that of the adjacent bones.

Adult↗

PubMed1989

Determining carpal collapse. An improved method.

The carpal height index (carpal height ratio of the diseased wrist divided by that of the normal wrist, as described by Kato et al.) was calculated in forty normal subjects, ten patients who had Stage-III lunatomalacia, and eight patients who had non-union of a fracture of the scaphoid. The method of Youm et al. for determining the carpal height index was altered to include the use of defined points of reference and a standardized radiographic technique. Two tests of reproducibility demonstrated the reliability of the method. The carpal height index was found to be superior to the carpal height ratio for the evaluation of unilateral disease. The mean carpal height index of diseased wrists differed significantly from that of normal wrists. The carpal height index (for unilateral disease) or the carpal height ratio (for bilateral disease) can be used to describe the progression of collapse of the wrist quantitatively and to evaluate and compare various forms of treatment.

Adolescent↗

PubMed1988

[Electronic medical history: utopia or reality?].

With the advent of computers in medicine, the patient's chart has a more varied function. The basic use has been as the physician's instrument to provide information about diseases and their evolution. In order to link the physician with the capacity of a computer, a common language was elaborated based on the patient's chart. Computerized charting now makes possible not only improved communication and administration but also serves as a statistical databank. Important applications of a medical databank are statistical analysis of the chart, quality control of medical practice and facilitation of scientific studies. The patient's chart becomes a powerful multifunctional instrument in the clinic, the practice, and in research.

Electronic Data Processing↗

PubMed1987

The late reconstruction of the ligament of the metacarpo-phalangeal joint of the thumb.

The disruption of the ligaments at the level of the MP-joint jeopardizes the function by lack of stability. The reconstruction by free tendon grafting, anchored in a dorso-lateral plane in the metacarpal an in the proximal phalanx, restores stability and good functional results in spite of a slight amount of loss of flexion. Two out of 25 operated thumbs failed and fusion of the MP-joint was necessary. A minimal limitation of flexion may be desirable since a tendon graft never restores a full physiological function. Our data show no need for K-wire transfixation of the MP-joint, since there is no evidence of a difference in late stability with or without such additional fixation. The mean pinch-grip pressure, restored to normal in the majority of cases, was not influenced by the mentioned reduction of flexion nor by the amount of stability restored.

Arthrodesis↗

PubMed1986

[Anatomic basis of a new concept of stability of the carpus].

Based on anatomical and biomechanical evidence, we conclude that the stability of the carpus relies on the lunate bone which is the centre of the longitudinal as well as the transverse functional axis. The lunate is firmly stabilised proximally to the radius and the radio-ulnar ligament complex by the proximal V-ligament, and so becomes a weight bearing structure. It is anchored by strong ligaments to the scaphoid on one side and the triquetrum on the other, thus forming a 3-bone intercalary system, which is in turn guided by the palmar distal V-ligament and the dorsal radio-triquetral ligament.

Biomechanical Phenomena↗